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CELIAC DISEASE – FROM PATHOPHYSIOLOGY TO ADVANCED THERAPIES

CELIAC DISEASE
Edited by Peter Kruzliak and Govind Bhagat .

Celiac Disease (CD) or Gluten Sensitive Enteropathy (GSE) is a life‐long disorder. It is 
characterized by inflammation in the small intestine of genetically predisposed 
individuals caused by inappropriate immune response to gluten, a protein enriched in 
some of our common grains (wheat, rye and barley). The toxicity of gluten is 
manifested by the autoimmune action of T‐lymphocytes on mucosal cells in the small 
intestine, disrupting its vital function of absorbing 
nutrients from food. Epidemiological studies conducted during the past decade 
revealed that CD is one of the most common lifelong disorders worldwide. CD can 
manifest with a previously unsuspected range of clinical presentations, including the 
typical malabsorption syndrome and a spectrum of symptoms potentially affecting 
any organ system. Since CD is often atypical or even silent on clinical ground, many 
cases remain undiagnosed and exposed to the risk of long term complications, such as 
anemia and other hematological complications, osteoporosis, neurological 
complications or cancer.
In recent years, there have been noticeable shifts in the age of onset of symptoms and 
in the clinical presentation of CD, changes that seem to be associated with a delayed 
introduction of gluten coupled with its reduced amount in the complications in the 
diet. Another controversial topic concerns the complications of untreated CD. Multiple 
studies that have focused on the biochemistry and toxicity of gluten‐containing grains 
and the immune response to these grains suggest that individuals affected by CD 
should be treated, irrespective of the presence or absence of symptoms and/or 
associated conditions. Nevertheless, there is general agreement that the persistence of 
mucosal injury, with or without typical symptoms, can lead to severe complications in 
CD patients who do not strictly comply with a gluten‐free diet.
Research into gluten sensitivity has never been more popular nor more exciting. With 
regard to gluten sensitivity we are in a period of great change occasioned by the 
application of new methods to identify gluten sequences as T‐cell antigens, the study 
of genetic and mollecular pathophysiology, the use of immunohistocytochemical and 
mRNA probing response to gluten and the research of future therapeutic options.
This book covers most of the aforementioned controversial and yet unresolved topics 
by including the contributions of experts in CD. What the reader will surely find 
stimulating about this book is not only its exhaustive coverage of our current 
knowledge of CD, but also provocative new concepts in disease pathogenesis and 
treatment.
To do this book would have been impossible without the contributions of friends and 
colleagues from around the world who have devoted so much interest to the project. It 
has also been necessary for them to master the unique chapter‐writing skills required 
of every manuscript in this book. This projet would not have been possible without the 
expertise and invaluable contribution and technical support of Ms. Romina Skomersic 
and Ms. Natalia Reinic and of the InTech publishing team.
It has been a privilege to put together „Celiac Disease ‐ From Pathophysiology to 
Advanced Therapies“ that is offered in the hope that its pages will contain the 
necessary information for researches, gastroenterologists, physicians, and others who 
are interested in this field of medicine and science.
Even if I do not give you any big answers in this book, I am still proud that you are 
holding it in your hands. It is because I learned, during my time as an editor and 
author of this book, that even if we do not reach the endpoint of our journey, we can 
still make a great contribution travelling to it.

Peter Kruzliak, M.D., BSc.
5th Department of Internal Medicine
University Hospital and Medical Faculty of Comenius University
Bratislava,
Slovakia

CONTENTS :

Section 1 New Insights on Pathophysiology of Celiac Disease 1


Chapter 1 Mucosal Expression of Claudins in Celiac Disease 3
Dorottya Nagy-Szakál, Hajnalka Győrffy, Katalin Eszter Müller, Kriszta Molnár, Ádám Vannay, Erna Sziksz, Beáta Szebeni, Mária Papp, András Arató and Gábor Veres

Chapter 2 Antioxidant Status of the Celiac Mucosa: 
Implications for Disease Pathogenesis 17
Vesna Stojiljković, Jelena Kasapović, Snežana Pejić, Ljubica Gavrilović, Nedeljko Radlović, Zorica S. Saičić and Snežana B. Pajović

Chapter 3 Heat Shock Proteins in Coeliac Disease 37
Erna Sziksz, Leonóra Himer, Gábor Veres, Beáta Szebeni, András Arató, Tivadar Tulassay and Ádám Vannay

Section 2 Clinical Manifestations and Complications of Celiac Disease 69


Chapter 4 Celiac Disease and Diabetes Mellitus Type 1 71
Mieczysław Szalecki, Piotr Albrecht and Stefan Kluzek

Chapter 5 Hematologic Manifestations of Celiac Disease 83
Peter Kruzliak

Chapter 6 Multiple Sclerosis and Celiac Disease 101
Carlos Hernández-Lahoz and Luis Rodrigo

Section 3 Detection of Cereal Toxic Peptides Based on New Laboratory Methods 113


Chapter 7 Sensitive Detection of Cereal Fractions that 
Are Toxic to Coeliac Disease Patients, Using Monoclonal Antibodies to a Main Immunogenic Gluten Peptide 115
Carolina Sousa, Ana Real, Mª de Lourdes Moreno and Isabel Comino

Section 4 Advanced Therapies in Celiac Disease 137


Chapter 8 Enzyme Therapy 
for Coeliac Disease: Is it Ready for Prime Time? 139
Hugh J. Cornell and Teodor Stelmasiak

Section 5 Follow-up of Patients with Celiac Disease 165


Chapter 9 Principles and Strategies 
for Monitoring Individuals with Celiac Disease 167
Mohsin Rashid

Chapter 10 On Treatment Outcomes 
in Coeliac Disease Diagnosed in Adulthood 179
Claes Hallert and Susanne Roos .


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Published by: younes younes - Monday, January 28, 2013

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